Hatanaka Takeshi, Saito Naoto, Kakizaki Satoru, Hiraoka Atsushi, Tada Toshifumi, Kariyama Kazuya, Tani Joji, Takaguchi Koichi, Itobayashi Ei, Ishikawa Toru, Toyoda Hidenori, Kawata Kazuhito, Naganuma Atsushi, Yata Yutaka, Ohama Hideko, Matono Tomomitsu, Tada Fujimasa, Nouso Kazuhiro, Morishita Asahiro, Tsutsui Akemi, Nagano Takuya, Nakamura Shinichiro, Kumada Takashi
Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan.
Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.
Oncology. 2025;103(2):94-106. doi: 10.1159/000541002. Epub 2024 Aug 20.
Gastrointestinal varices rupture is considered to be prone to occur during atezolizumab and bevacizumab (Atez/Bev) treatment. This study aimed to investigate predictive factors affecting the increase in spleen volume (SpV) and the association of SpV variation with the clinical outcomes of Atez/Bev.
A total of 164 HCC patients were included in this retrospective multicenter study. We measured SpV based on CT scans obtained before treatment and at evaluations. We used the inverse probability of treatment weight to address the imbalance between patient characteristics.
The median pretreatment SpV was 184 (130-257) cm3 and the median SpV variation was 27 (9-60) cm3. An increase in the SpV was observed in 140 patients (85.4%). Age <74 years (p = 0.03), mALBI grade 2b or 3 (p = 0.03), and pretreatment SpV ≥184 cm3 (p < 0.001) were significantly associated with increased SpV. There were no significant differences in progression-free survival (PFS) or overall survival (OS) between patients with SpV variation <25 cm3 and those with SpV variation ≥25 cm3 in the crude (p = 0.3 and 0.7) and IPTW-weighted cohorts (p = 0.08 and 0.8, respectively). Regarding pretreatment SpV, there were no significant differences in PFS or OS between patients with and without pretreatment spleen enlargement in the crude (both p = 0.3) and IPTW-weighted cohort (p = 0.6 and 0.3, respectively).
Caution is warranted to detect the aggravation of portal hypertension when administering Atez/Bev to young patients or patients with an impaired liver function or pretreatment spleen enlargement. The impact of spleen modulation by Atez/Bev appears to be limited on clinical efficacy.
胃肠道静脉曲张破裂被认为在阿替利珠单抗和贝伐珠单抗（阿替利珠单抗/贝伐珠单抗）治疗期间容易发生。本研究旨在探讨影响脾体积（SpV）增加的预测因素以及SpV变化与阿替利珠单抗/贝伐珠单抗临床结局的关联。
本项回顾性多中心研究共纳入164例肝癌患者。我们根据治疗前和评估时获得的CT扫描测量SpV。我们使用治疗权重的逆概率来解决患者特征之间的不平衡问题。
治疗前SpV的中位数为184（130 - 257）cm³，SpV变化的中位数为27（9 - 60）cm³。140例患者（85.4%）观察到SpV增加。年龄<74岁（p = 0.03）、mALBI 2b或3级（p = 0.03）以及治疗前SpV≥184 cm³（p < 0.001）与SpV增加显著相关。SpV变化<25 cm³的患者与SpV变化≥25 cm³的患者在粗数据（p = 0.3和0.7）和IPTW加权队列（分别为p = 0.08和0.8）中的无进展生存期（PFS）或总生存期（OS）无显著差异。关于治疗前SpV，在粗数据（两者p = 0.3）和IPTW加权队列（分别为p = 0.6和0.3）中，有和没有治疗前脾肿大的患者在PFS或OS方面无显著差异。
在给年轻患者、肝功能受损患者或有治疗前脾肿大的患者使用阿替利珠单抗/贝伐珠单抗时，有必要谨慎检测门静脉高压的加重情况。阿替利珠单抗/贝伐珠单抗对脾脏的调节作用对临床疗效的影响似乎有限。
